Facial Feminization Surgery (FFS) and Insurance Coverage

For many individuals seeking Facial Feminization Surgery (FFS), the financial aspect can often feel overwhelming. Although insurance coverage has been a viable option in certain cases, navigating claims remains a complex process. 

At Facialteam, we noticed a small group of insurance companies have helped our patients with mostly partial, but in a very few cases, complete reimbursement of surgical costs. Below we mention some key considerations and how we support our patients who seek insurance coverage for facial gender affirming surgery (FGAS).

Insurance Companies Facialteam Has Worked With

Facialteam has supported patients who are managing their own insurance claims for financial coverage of FGAS or facial feminization. These medical insuring entities include:

• Blue Cross Blue Shield of Texas;
• LAYA Healthcare;
• Techniker Krankenkasse;
• SWICA GESUNDHEITSORGANISATION;
• MHPlus Betriebskrankenkasse;
• Cigna;
• MENZIS;
• SIGNAL IDUNA GRUPPE;
• Transbide – Hacienda Foral de Navarra;
• Ditzo Healthe Insurance;
• Allianz Care;
• Blue Cross Blue Shield (BCBS);
• Adeslas.

Our experience with these companies has shown that partial or full reimbursement for surgery is possible. The process will nevertheless include rejections and reviews, plus will undoubtedly require prior authorization–which you should note is not a guarantee of exact coverage although we haven’t seen incidents to date.

Does Insurance Cover FFS?

Yes, FFS can be covered by insurance, but this depends on several factors, including your insurer, your specific policy, and the state, region or country you live in. Many insurance providers now recognize FFS as a medically necessary procedure for gender-affirming care, as stated by WPATH and the WHO, but it’s crucial to verify this with your insurer.

Securing insurance coverage for FFS typically requires a thorough understanding of your policy and its terms. You will undoubtedly be asked to present various documents, letters or reports to help you get through the hoops. Here are the steps to improve your chances of obtaining coverage:

1. Review Your Insurance Policy: Confirm whether your plan includes coverage for gender-affirming surgeries. Look for specific terms related to “transgender healthcare” or “medically necessary procedures.”
2. Obtain a Letter of Medical Necessity (LMN): This document from your healthcare provider like Facialteam explains why FFS is a medically necessary part of your gender-affirming treatment. Many insurance companies require this to process your claim.
3. Pre-authorization: Many providers mandate prior approval for FFS. Facialteam can assist with gathering the necessary documentation to facilitate this process.
4. Submit Clinical Documentation: This includes psychological evaluations, diagnosis codes, and surgery plans.
5. Proof of Multidisciplinary Care: Some insurance companies will require proof of MDM, or multidisciplinary management of care. This will involve a team of professionals under contract, such as a mental health professional who typically acts as case manager, a GP or family doctor, surgeon if relevant, etc that lay out a clear program of clinical sessions in which each patient’s care is reviewed and discussed. 
6. Appeal Denials: If your claim is denied, don’t give up! Many patients succeed on appeal after providing additional evidence or documentation.

How Much Does FFS Cost With Insurance?

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Timing with Insurance Coverage for FFS

Unfortunately, medical insurance will rarely make upfront payments, prior to surgery. 

Although it is Facialteam policy to require full payment in advance of surgery, when working with a case manager and with the guarantee of an officially recognized insurer, patients may proceed with surgery under the condition that a deposit has been made and a consent of financial responsibility in the event of any failure on behalf of their insurance is signed.

Insurance coverage for FFS can vary depending on the provider and individual policy. Generally, coverage falls into one of the following categories:

1. Partial Reimbursement: The insurance company covers a portion of the surgical costs.
2. Full Reimbursement: The total cost of the surgery is covered by the insurer.

How Facialteam Supports You With Your Insurance

Navigating insurance claims for FFS can be challenging, but our team is here to help. If you are seeking prior authorizations or submitting reimbursement claims, we want to support you in building a claim.

There are many online resources nowadays that help people with medical insurance claims for facial reconstruction and a growing volume of scientific literature on the subject that is unveiling the limited coverage of facial feminization and the implications of policy restraints. Unfortunately, most insurers limit “out-of-network” providers such as Facialteam.

If you are in the US, Out 2 Enroll is a platform designed to help you find the insurance you need. Here are a few other US-based resources noted by Gaines of Healthy Trans:

• The Gender Affirming Letter Access Project maintains a listing of therapists who provide letters for free: https://thegalap.org/
• Trans Family support services are experienced in navigating transitional journeys: https://www.transfamilysos.org/
• The Movement Advancement Project maintains a map of state health insurance rules about transgender care.
• The National Center for Transgender Equality maintains many healthcare specific resources, including information about transgender Medicare coverage

Facialteam has over 14 years of experience in providing world-class FFS procedures, focusing on patient safety, satisfaction, and care. Our team’s commitment to excellence extends beyond surgery, ensuring that each patient feels supported, both emotionally and financially, throughout their journey.